Prognostic Value of T-wave Positivity in Lead aVR in COVID-19 Pneumonia.

OBJECTIVE: T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS: A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76-14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65-15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001-26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001-1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115-1.848; p=0.005) were independent risk factors for mortality. CONCLUSION: A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.

Acute Disseminated Encephalomyelitis (ADEM) After Consecutive Exposures to Mycoplasma and COVID Vaccine: A Case Report.

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system, commonly triggered by viral infections or after immunization. ADEM occurrences in adults are rare. Full spectrum of complications is unknown for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines. A previously healthy 44-year-old female presented to the emergency room (ER) with acute onset of tingling, numbness, and weakness of both lower extremities, urinary retention, blurred vision in right eye, and midline lower back pain. Physical examination revealed bilateral lower extremity weakness 1/5, absent deep tendon reflexes, and decreased sensation. She received the first dose of SARS-CoV-2 vaccine six days prior to presentation to ER. Imaging of her lumbar spine and head were consistent with an active demyelinating plaque consistent with demyelinating disease either multiple sclerosis (MS) or ADEM. The patient was started on SoluMedrol 500 mg IV twice daily for five days. Serological workup and CSF analysis were nonsignificant except for Mycoplasma pneumonia IgM, elevated myelin basic protein, and positive IgG, IgA, and IgM. Patient gradually improved and was transferred to rehabilitation. Repeat MRI brain and spine showed improvement in previous lesions. However, she had worsening left eye symptoms that prompted her transfer to another facility for plasmapheresis. Plasma exchange was done for five treatments for ADEM. Patient started noticing improvement in vision and was discharged on steroid taper. We report a case of a possible association between ADEM and SARS-CoV-2 mRNA vaccine. It should be considered in the differential diagnosis in any case suggestive of acute demyelination after COVID-19 vaccination.

The Effect of Digital Activities on the Technology Awareness and Computational Thinking Skills of Gifted Students (eTwinning Project Example)

The aim of this study was to examine the effect of interdisciplinary activities organised online within the scope of an eTwinning project carried out with gifted students on the students' technology awareness and computational thinking (CT). However the research was not funded by eTwinning. The study was carried out through web-based tools for a period of 3 months in the year 2020. These Web 2.0 tools were: Canva, Zoom, Google Classroom, Jamboard, Tinkercad, Telegram, Facebook, Kahoot!, Instagram, StoryJumper, Padlet, etc. The research was designed with an explanatory design which is one of the mixed models. While in the quantitative aspect of the study, a quasi-experimental design with pretest posttest control group was carried out, a case study was carried out in the qualitative aspect of the study. The participants were 50 gifted students continuing their education at Science and Art Centres affiliated to the National Education Ministry in 6 different provinces of Turkey. Quantitative and qualitative methods were used together in the study. A technology awareness and computational thinking scale was chosen as the quantitative data collection tool, while mind maps were used as the qualitative data collection tool. As a result of the research, a significant increase in the participants' technology awareness and computational thinking was determined in favour of the posttest, while this increase was verified through the mind-mapping technique applied to the students. At the end of the study, the findings were discussed, and recommendations were made for future studies. In addition, a great limitation of this research was the effectiveness of activities that had to be carried out entirely remotely due to the COVID-19 pandemic. In the distance education, in which the teacher's control was weak, the skills intended to be fostered in students remained at a lower level.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases.

BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

COVID-19 experience of the major pandemic response center in the capital: results of the pandemic's first month in Turkey

Background/aim: The aim of this study is to evaluate the epidemiological and clinical characteristics and parameters that determined the clinical course and prognosis of the COVID-19 patients admitted to Ankara City Hospital during the first month of the pandemic in Turkey. Materials and methods: SARS-CoV-2 PCR positive patients who were hospitalized between March 10 and April 10, 2020 were included. Results: Among 222 patients, mean age was higher in severe acute respiratory illness (SARI)/critical disease group (P < 0.001). Median time from illness onset to admission and presence of comorbidity, especially coronary artery disease and chronic obstructive pulmonary disease, were significantly higher in the SARI/critical disease group (P < 0.05). Cough and fever were the most common symptoms, while anosmia and loss of taste were observed in 8.6% and 7.7% patients, respectively. The mortality rate was 5.4%. A high neutrophil/lymphocyte ratio; low lymphocyte, monocyte, and platelet count; elevated liver enzymes; low GFR; and high levels of muscle enzymes, ferritin, and IL-6 on admission were found to be associated with SARI/critical disease (P < 0.05). Bilateral ground-glass opacity and patchy infiltration were more frequently seen in the SARI/critical disease group (P < 0.001). Patients older than 65 years had an 8-fold increased risk for development of SARI/critical disease. Conclusion: This cohort study regarding COVID-19 cases in Turkey reveals that older age, presence of comorbidity, bilateral infiltration on CT, high neutrophil/lymphocyte ratio, low monocyte and platelet count, elevated liver enzymes, low GFR, high levels of muscle enzymes, and high levels of ferritin and IL-6 on admission are predictors of SARI and severe disease.